What is Pediatric Speech Therapy?

1. Dysphonia is abnormal, that is, the speech is not clear, some children have errors in individual pronunciations, and some have so many errors that others do not understand. There are several common articulation abnormalities:

Speech and language disorders in children

Language is an important ability in learning, social interaction, and personality development. Broadly speaking, children's language and language disorders (also known as communication disorders) affect reading and writing in the future. Therefore, early detection, early diagnosis and timely treatment are particularly important. In recent years, clinical diagnosis and treatment of children's speech and language disorders have been carried out in China.

Signs and symptoms of speech and language disorders in children

(1) Root rooting: It means to replace most voices with root root sounds such as g, k, and h. Into "hair cover carry". These children often use tongue root fricatives instead of the front tongue.

(2) Anterior tongue accentuation: replace some voices with anterior tongue d, t. For example, "turtle" is called "wudui", "park" is called "dongyuan", "pants" is called "rabbit" .

(3) Non-aspirated sound: Many sounds in Chinese such as p, t, k, c, s, etc. are aspirated sounds. It is an error when a child replaces the aspirated sound with an aspirated sound. For example, "mother-in-law" is described as " " and "bubble" is described as "hug", which illustrates the problem of children's airflow and voice coordination.

(4) Omitting voicing: that is, omitting some parts of speech. For example: "Airplane" omits "Fei" after omitting the consonant "Fly"; or omitting or simplifying complex rhyme ao, ie, iu, ang, etc. Into a "doll".

2. Voice problems Voice problems can be either functional or organic, manifested as abnormalities in tone, loudness, and sound quality. These anomalies can exist alone, but often have speech or language problems at the same time, thus forming a complex communication barrier.

The most common sound quality problems are hoarseness, persistent or progressive hoarseness, especially with wheezing or audible breathing sounds, which require further fiberscope examination to detect papillary papilloma, congenital sound Door webs, or vocal nodules. Children's vocal nodules are often caused by speaking loudly or constantly. Vocal cord palsy appears as a soft or absent voice, weak, gasp-like crying.

Resonance abnormalities are manifested as excessive or light nasal sounds, children's cleft palate, submucosal cleft palate, and neurological dysfunction affecting glottal closure problems that cause nasal sounds to be excessive; severe upper respiratory infections or rhinitis can cause nasal sounds to be too light. Chronic nasal vocalization can occur in children with adenoid hypertrophy.

3. Fluency problems Children's fluency problems are manifested as pauses, repetitions, prolongation and obstruction in speaking. It usually starts in children 2 and a half to 4 years old.

(1) Repetition: In children's speech and language development, repetition can be regarded as a normal phenomenon. But when repetition is too frequent, more than 50 repetitions per 1,000 words require intervention.

(2) Extension: Prolong a voice when speaking a word.

(3) Joint movements: When children do not speak fluently, there are some movements such as face distortion, wide mouth, tongue extension, stare, jaw convulsions, etc.

(4) Language problems: Children with language problems often use the terms of language retardation and language barriers. Language retardation means that children's language development follows the order of normal children, but at a slower rate. Language impairment means that children's language development deviates from the normal order, and language learning methods are often different.

The obvious clinical manifestation is the problem of language expression. Some children are slow to speak, and some speak significantly less than their peers. Children's language problems are generally divided into 3 types:

Language expression disorder: Children's language comprehension is normal, but expression is particularly difficult, and there is no pronunciation difficulty caused by physical defects.

Mixed disorders of language feelings and expressions: children can hear sounds, but they are confused; they can understand gestures or gestures, can learn to read but cannot express.

Language information processing problem: children speak fluently, but the content is very superficial, and it is difficult to keep the topic in language communication. Children only focus on the topic they choose.

Pediatric speech and language disorders medication

1. Treatment of dysarthria

(1) Sound-producing program: Most children with incorrect pronunciation do not realize their problems. Therefore, at the beginning of treatment, children's incorrect pronunciation needs to be exaggerated and compared with the correct sound, so that children can listen to the correct and wrong sounds in the recorder. The sound requires its identification. Once the child can completely recognize it and realizes that he has mispronounced it, he will enter the following levels of treatment.

Phoneme level treatment: When the child has several wrong pronunciations, the treatment always chooses the earliest sound (that is, the easiest sound) that appears in normal children to start with. This sound is called the target sound. First, it helps children recognize the correct sound of the target sound. Mouth shape and other characteristics, followed by hearing training, that is, distinguishing the target sound from another sound, then let the child compare the difference between the target sound and the correct target sound, establish the correct perception, and finally use the voice localization method to let the child see The movement of the lip, tongue, and jaw of the therapist and the shape of the mouth when the target sound is made, let the child imitate the pronunciation in front of the mirror. Some children cannot immediately learn to pronounce the target sound during this process. Therefore, the therapist should look for transition sounds that are close to the target sound, and the child will also make transition sounds. The imitation learning of the transition sounds gradually extends to the target sound. During this period, children are required to Use the mirror as visual feedback to observe the position of your lips, tongue, and jaw. Some of the pronunciations must even experience the vocal cord vibration with your hands. When the child learns to make a target sound, he continues with the next treatment.

Syllable level treatment: A new target sound is often fragile and unstable at the beginning. If it is not strengthened in syllable and subsequent level treatment, it is easy to lose or still return to the original wrong pronunciation. Syllable level treatment is to make the target sound and other vowels or consonants into meaningless syllables, so that children can consolidate the target sound when learning syllables. Only after the syllables are completely and correctly emitted can they be postponed to the next level of treatment. .

Word-level therapy: The therapist then applies the target sound to meaningful words. This new pronunciation can be placed at the beginning, middle, or end of a word. The level of the word should be consistent with the cognitive level of the child, and it often occurs in daily life. In the treatment, words can be combined with corresponding pictures to increase interest.

Sentence-level treatment: The therapist selects sentences that are suitable for children, and slows down speaking, repeats, imitates, and speaks with children. When repeating, children must follow the tone, intensity, and rhythm of the therapist's speech. Therapists deliberately issue children's past incorrect pronunciations when speaking, and train children to be good at detecting and correcting themselves.

(2) Oral function training: Oral motor function problems can affect speech intelligibility. Therefore, children who have clinically found such problems must perform oral function training; including enhancing the proprioception of the oral mucosa, that is, requiring daily pressure or gentle and rapid battering of children's cheeks, jaws, and lips; using a soft and hard toothbrush or Silicone rods stimulate the tongue, gums, buccal mucosa and hard palate in the mouth; improve food texture, from soft to hard. Improve oral coordination movements such as teaching bubbles blowing, horns, sucking with a straw, imitating animal calls, rapid oral rotation, etc.

2. Treatment of Speech Abnormalities Speech therapy includes 4 aspects, namely, setting goals, methods, strategies, and family cooperation.

(1) Setting goals: When setting goals for speech therapy, Vygotsky's "closest development level" theory is the dominant principle, that is, the goals should be set slightly higher than the developmental level of individual children, but can Make children reachable with help. For example, when the child can only speak one word, use overlapping words during treatment, and then develop to two-word words; when the child can only say phrases that do not form a sentence, the words are slightly expanded during the treatment, allowing the child to imitate and make him Build a pattern and gradually transition to sentences.

(2) Therapeutic methods: Speech therapy should be performed in meaningful situations, accompanied by toys and games. There are two methods of speech therapy. One is a therapist-centric approach, which mainly uses three forms of practice, in-game training, and shaping:

Exercise: Give the child a task and tell him to respond. For example, the form of doctrine words or words is monotonous, and children often lack motivation.

Drilling in the game: First, give the child a game activity, and ask the child to learn the set language goals according to the requirements. When the goal is completed, give the child an interesting game activity to strengthen the target's response.

Shaping: It is to give children auditory stimulation, and gradually induce children to have a response close to their goals.

These three forms are carried out under a structured arrangement by the treating staff and are suitable for young children or children with severe language abnormalities. The other is a child-centric approach. The therapist takes the goals set as part of the game, talks to the child and plays, and intentionally guides the child. Once the child reaches the set goal, the therapist gives feedback and communicates with him. In the process of interaction between therapists and children, the skills of imitation, word formation, and expansion are continuously applied as demonstrations. This method is suitable for stubborn and shy children, as well as preschool children with certain language skills.

(3) Therapeutic strategy: For children who have not yet spoken but only understand, the intervention of pre-language stage is adopted for the treatment. The intervention includes attention to sounds and objects, playing with others, and playing some turns and imaginative games. The strategies used in the intervention are as follows:

Use words or reduplicates as language stimuli and repeatedly apply them to the environment, which is called "listening bombing".

Match items and toys of interest to children with words.

Encourage children to communicate with gestures and voices, regardless of poor pronunciation.

Communicate with children in the simplest language.

Correct bad communication such as crying, anger, throwing things.

Create situations to encourage children to communicate with others and respond quickly.

For children who already have language but have little content and simple forms, they are required to imitate the words of the therapist, induce spontaneous expression, and apply it in life. The strategy used in the intervention is to imitate children in imaginative games. Therapists use gestures and actions to strengthen children's feelings in the exemplary language; stimulate children's conscious communication; create opportunities for dialogue with children; teach children's life terms in role-playing games, such as going to the store for shopping and receiving friends Etiquette, etc.

(4) Family cooperation: Parents and caregivers play a very important role in children's language development and language therapy. Parents need to be actively involved in applying methods and strategies of speech therapy in their lives to work towards the stated goals of therapy. Today's clinical language therapy model is the collaboration and cooperation between the therapist and the family, which has proven to be fruitful in practice.

3. Treatment of voice problems In the field of pediatrics, voice therapy is mainly used for vocal training of hearing impaired and mentally retarded children, including training of tones, loudness, unvoiced sounds, attack sounds and vocalizations. At present, computer multimedia functions have been used in China, and clinical medical software is used as a treatment method, combined with other methods in individual therapy such as changing loudness, throat massage, half-swallowing, changing tongue position, reducing hard attack, relaxation, and breathing training And so on, to achieve a therapeutic effect.

4. The treatment of language fluency in young children It is difficult to distinguish between language fluency and stuttering in young children. When this fluency is very frequent, indirect treatments such as children's games, parental guidance, and changes in parents and children Communication methods, adjustment of environment, etc. The reason for the indirect treatment is to avoid the tension caused by deliberate correction of language fluency. The therapist should advise the family not to correct the child's fluent speech, and let him repeat and recite. Some game situations such as story Solitaire, nursery rhymes, nursery rhymes, etc. can be designed to promote language fluency.

Pediatric speech and language disorders

Don't eat greasy foods, usually parents should make more foods that children can easily digest.

Preventive care for children with speech and language disorders

Since birth, children should live in a rich language environment and undergo regular hearing screening and developmental monitoring. If abnormalities are found, they should intervene immediately. In the clinic, it is very important to recognize early warning signs of language development abnormalities to further confirm the existence of the problem and early intervention.

Warning signs of language abnormalities:

Within 1.12 months

(1) No smile on familiar voice and face for 2 months.

(2) No smile on others for 3 months.

(3) Do not attempt to imitate sound for 4 months.

(4) 8 months without teeth.

(5) Do not play or show no interest in "hide and seek" games for 8 months.

(6) Can't say a word for 12 months.

(7) 12 months without any gesture, such as waving goodbye or shaking his head.

(8) No items or pictures can be pointed for 12 months.

2.12 24 months

(1) 15 words cannot be used in 18 months.

(2) In 18 months, gestures were used instead of speaking to express demand.

(3) 18 months of reluctance to imitate sounds or use consonants and vowels with limited use.

(4) 2 years old cannot speak two words.

(5) 2 years old cannot imitate words or actions.

(6) 2 years old cannot follow simple instructions.

3.24 36 months

(1) 3 years old can not compose words into phrases or sentences.

(2) 3 years old cannot communicate with others spontaneously.

(3) 3 years old can't send "b, p, m, d, t, n, l, g, k, h" correctly.

(4) often express frustration when communicating with people.

(5) Limited to playing certain toys or playing certain toys repeatedly.

(6) Limited vocabulary.

(7) Can't socialize or play with others.

4.4 years

(1) Outsiders (non-family members) do not understand what they say.

(2) You cannot repeat simple stories or clearly remember recent events.

(3) Sentences are wrong, or some sounds are replaced or omitted.

Pathological causes of speech and language disorders in children

Hearing disorders of various causes affect speech disorders; mental retardation of various causes is the most common cause of speech disorders; suffering from neuropsychiatric diseases such as neurological disorders, autism, anxiety, etc., or the effects of social and environmental issues Both can cause speech disorders.

Diagnosis of speech and language disorders in children

Distinguish it from mental retardation, depression, and attention deficits that affect learning and communication.

Pediatric speech and language disorders examination methods

Laboratory inspection:

No special findings during general inspection. Genetic factors can be found in chromosomal abnormalities.

Other auxiliary checks:

EEG, brain CT and other examinations should be done to understand whether there are intracranial lesions and injuries.

Complications of speech and language disorders in children

May have pharyngeal papilloma, congenital glottis webbing, or vocal nodules, vocal cord palsy paralysis; upper respiratory tract infection or rhinitis, adenoid hyperplasia hypertrophy affecting vocalization; children's cleft palate, submucosal cleft palate, neural dysfunction, Affects glottal closure; school age can cause significant lag in academic performance and difficulty in communicating with others.

Prognosis of speech and language disorders in children

There are many factors that affect prognosis, such as IQ and family status. Follow-up studies have shown that prognosis for long-term speech and language disorders is generally poor, such as high dropout rates, low employment rates, and low socioeconomic status. The relationship between speech and language disorders and conduct disorders, emotional disorders and juvenile delinquency needs further investigation and discussion.

Pathogenesis of speech and language disorders in children

1. Children's language development Language includes both verbal and non-verbal components. These two are dynamic and interactive processes that begin with the early development of children. Because language development is affected by biological factors and the environment, individuals vary greatly. There are gender differences in language development and brain functions related to language. Recent studies on language using functional magnetic resonance have shown that in language information processing, women have more activation in the nervous system than men; activation of the male brain has one side advantage, mainly in the left frontal horn gyrus, In women, the corresponding areas of the brain on both sides are more active. This may explain why boys have more language problems than women in early childhood. The language development process is as follows:

(1) Pre-language period (birth ~ 12 months): When children have used language before speaking, and the communication mode is non-verbal, such as eye contact, smile, etc. In the way of communication, gradually learn the rules of language communication. For example, adults and children play a "hide-and-cat" game, which reflects common participation, and cultivates children's "turn-around" behavior in interactions. In this period, children mainly started to pronounce. About 3 to 4 months, children had repeated babbling sounds. At 8 months, they had a combination of consonants and vowels. At 12 months, they would use 1 word. At the same time, gestures are used to indicate meaning, such as waving goodbye, and clicking pictures with little fingers.

(2) Initial language period (1 to 3 years old): At this time, children use words to indicate what they already know, and use words to communicate with others, but they reflect the self-centered characteristics. In spite of this, children continue to communicate nonverbally and in combination with the way they speak. Children from 12 to 18 months will use words, and the vocabulary will increase to 20; children from 18 to 24 months will enter the stage of combining two words. If children are familiar with a certain thing, they can combine according to the rules in communication. Words began to appear in sentences. At this stage, the number of vocabularies increased to hundreds, the ability to imitate increased, the topics in communication increased, and it showed better flexibility. In children aged 24 to 36 months, the vocabulary increased significantly, and Applying the vocabulary you have learned in communication, for example, can express intention and quantity. At this time, children use words more appropriately, and they can express their emotions, hopes, and interests in special ways. A 3-year-old child can say his name, age, gender, common objects, pictures, and follow 2 to 3 consecutive instructions.

(3) Preschool (3 to 5 years old): children begin to appear more complicated language forms, such as prepositions (above, below, etc.), conditional sentences (if ... then), connectives (because of ... So, but). At this time, children are more proficient in expressing their intentions and meanings, and use appropriate communication in different situations. Preschool children will tell stories, follow 3 consecutive instructions, know how to look forward to future events such as "Tomorrow we go ...", they can respond to the question "Who, where, what", but to the question " "How, why" is difficult to answer (although they often ask others why). 4-year-olds speak clearly and understandably even in front of strangers.

(4) Early school age (5-12 years old): When children enter school, the environment's requirements for children are all expressed in language, such as requiring children to keep quiet in the classroom, teachers to teach knowledge, and assign homework. In large groups, children are required to abide by the "rotational" rules, use language appropriately and flexibly, ensure the success of their studies, and adapt to the school environment, and develop children's semantics in the process. During this period, children learn new words related to their studies, gain new information and instructions, and master specific disciplines. At the age of 7 to 8, children use abstract language to think about problems. By the age of 12, many aspects of cognition and language ability are like adults.

2. Pathogenesis

(1) Hearing impairment: Hearing is an important channel for language perception. When children's hearing is damaged, whether it is conductive or sensory, they cannot correctly perceive sound signals and produce language development of varying degrees. Delay, the severity of the delay is affected by a variety of factors, such as the degree of hearing impairment, the age at which it occurs, the age at which hearing is corrected, the appropriateness of treatment, and so on. Conductive hearing impairment is accompanied by recurrent and long-term otitis media with simultaneous exudation, which can have an adverse effect on early speech and language development. Although conductive hearing impairment generally does not exceed 20-30dB, and the maximum can be around 50dB, it obviously affects children's speech recognition. Long-term middle ear exudation can cause delay in language expression in early childhood and language problems in early school age. In addition, there are studies on the impact of auditory perception and auditory recognition on language, which shows that central auditory information processing problems make children's recognition, analysis and storage of auditory stimuli difficult, especially when they have similar sounds.

(2) Intellectual retardation: The most common cause of language retardation is mental retardation. Although the language development process is in the order of normal children, it is slower than normal children. When the environment requires more children's language, the language problem becomes more obvious. Some chromosomal and hereditary diseases are associated with language disorders. For example, children with trisomy 21 syndrome have varying degrees of language disorder; children with fragile X syndrome have special forms of rhythm and language content.

(3) Autism: An important feature of autism is communication disorder, which is accompanied by communication obstacles and stereotyped repetitive actions. Language disorders in children with autism can manifest as complete incomprehension, lack of language, or speech that is too rigid, academic, and exaggerated. There are also problems with language applications, echo-like language or non-verbal communication, almost no eye contact, and limited facial expressions and postures.

(4) Nervous system diseases: Children with cerebral palsy affect speech due to the barriers of neuromotor pathways, and often have dysarthria. Their ability to perceive language is much better than expression. Children's left brain lesions have a greater impact on language, reading, and writing than right brain lesions. Some children with left brain lesions in clinical practice often retain their original language skills because the right brain replaces the left brain's functions. This shows that the right brain has a plastic function. Brain damage or tumors cause children with acquired aphasia, that is, after the child develops the language ability to speak into sentences, the brain lesions cause language damage. Different types of aphasia appear clinically, for example, children with hearing impairment but fluent speech are called sensory aphasia; those who cannot name the target are called named aphasia; those who find it difficult to find appropriate words are called expressive Aphasia; speech is not fluent and laborious is called motor aphasia. In recent years, language disorders caused by some rare neurological factors have caused people's attention. This is acquired aphasia syndrome with convulsions, or Landau-Kleffer syndrome. This syndrome causes children with normal speech abilities to experience language regression and / or expression regression. The severity of this syndrome can reach complete hearing loss, that is, the sound of the environment cannot be recognized. The EEG manifestations of the children were abnormal, with sharp slow waves on both sides, and at least 2/3 of the children had various types of epilepsy. Some children's language ability can be restored, but 50% of children have severe language defects. Some children with hydrocephalus can express characteristics in language development: the use of long compound sentences, the vocabulary is more sophisticated, but there is no substantial content.

(5) Behavioral disorders: There is a close relationship between language disorders and behavioral problems. Both can be cause and effect. From the perspective of reasons, obvious emotional trauma or psychosocial adverse factors can affect children's language development or cause language disorders. For example, selective mutism is a less speech disorder that usually develops before the age of five, and the child does not speak in certain situations, such as school. These children generally have normal language, but may be caused by communication difficulties and often require months of treatment.

(6) Environmental deprivation: Children's language development is related to the environment. The vocabulary used by parents in their interactions with children, how to repeat and expand vocabulary in verbal communication is directly related to the growth of children's vocabulary and the speed of language development. The good development of children's language skills does not come from television or radio. If children are living in a lack of language stimulation and environment, they can cause language development retardation, and when these children are given therapeutic intervention, their language function improves significantly.